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Gastroenterology > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

what is viral hepatitis?

A

Inflammation of the liver due to a virus

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2
Q

what is the inflammatory mechanism of viral hepatitis?

A

infects cells in liver causing them to express MHC1 molecules, recognised by CD8+ cells and initiate cytotoxic killing and apoptosis?

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3
Q

what are the general symptoms of viral hepatitis?

A
  • Fever, malaise, nausea
  • Hepatomegaly
  • Pain
  • ↑ blood transaminase
  • ↑ atypical lymphocytosis
  • Jaundice
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4
Q

what is the definition of acute viral hepatitis?

A

<6 months

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5
Q

what is the definition of chronic viral hepatitis?

A

> 6 months

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6
Q

what are the types of viral hepatitis?

A

A,B,C,D,E

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7
Q

what is the structure of hepatitis A?

A

Picornvirus – not enveloped, contains single stranded RNA in protein shell (Epstein barr?)

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8
Q

what is the route of spread of hepatitis A?

A

faecal oral route

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9
Q

what is the incubation period of hepatitis A?

A

2-4 weeks

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10
Q

what are the clinical features of hepatitis A

A

o Always acute (no carrier state)
o Common in travellers
o Flu like symptoms
o Jaundice or hepatosplenomegaly

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11
Q

what is the diagnostic serology of hepatitis A?

A

 HAV IgM = Active

 HAV IgG = recovery or vaccination

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12
Q

what is the management of hepatitis A?

A

Supportive

Treatment

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13
Q

What is the structure of hepatitis E?

A

single stranded, non enveloped RNA, cosahedral virus (hepevirus, cytomegaly virus)

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14
Q

how is hepatitis E spread?

A

faecal oral

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15
Q

what is the incubation period of hepatitis E?

A

o Always acute

o Similar to Hep A but greater mortality risk in pregnancy

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16
Q

what is the diagnostic serology of hepatitis E?

A

o HEV IgM = Active

o HEV IgG = recovery

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17
Q

what is the management of hepatitis E?

A

Supportive

No vaccine

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18
Q

what is the structure of hepatitis C?

A

RNA flavivirus

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19
Q

how is hepatitis C spread?

A

Blood spread – childbirth, sex, IV drug users

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20
Q

what is the intubation period of hepatitis C?

A

6-9 weeks

21
Q

what are the two clinical presentations of hep C?

A

acute and chronic

22
Q

what are the clinical features of acute hepatitis C?

A

 Systemic – fatigue, nausea, joint pain, anorexia
 ↑ serum aminotransferase
 Jaundice

23
Q

what are the clinical features of chronic hepatitis C?

A

 Rheumatological problems – athralgia, arthritis
 Eye problems – sjogrens
 Cirrhosis
 Hepatocellular cancer
 Cryoglobulinaemia: typically type II
 Porphyria cutanea tarda
 Membranoproliferative glomerulonephritis

24
Q

what is the gold standard diagnostic test for hepatitis C?

A 
HCV RNA (with PCR)
•	Levels decrease = recovery
25
Q

what are the diagnostic tests for hepatitis C?

A

Enzyme immunoassay – HCV IgG (doesn’t indicate active or protective disease)
Recombinant immunoblot - ↑↓
 HCV RNA (with PCR)

26
Q

what is the management of acute hepatitis C?

A

supportive

27
Q

what is the management of chronic hepatitis C?

A

• Combination of protease inhibitors
o Daclatasvir + sofobuvir
o Sofosbuvir + simeprevir
• Interferon based treatments no longer recommended
• Liver transplant – virus recurs afterwards

28
Q

what is the structure of hepatitis B?

A

hepadnaviral
o Double stranded DNA
o Outer lipid envelope and an icosahedral nucleocapsid core

29
Q

what is the other name for hepatitis B?

A

yellow fevelr

30
Q

how is hepatitis B spread?

A 
o	Blood (body fluid?) spread – sex, vertically (more likely to be chronic)
Carriers exist
31
Q

what is the intubation period of hepatitis B?

A

6-20 weeks

32
Q

what are the serology features used in testing of hepatitis B?

A

o PCR can be used to look for makers
o HBV surface antigen – lives on surface = HBsAg
o Core antigen – lives in core of virus = HBcAg
o E Antigen – biproduct of replication = HBc = marker of active infection

33
Q

what are the clinical features of hepatitis B?

A

o Systemic – fever

o Jaundice

34
Q

what are the complications of hepatitis B?

A 
o	Chronic hepatitis
o	Fulminant liver failure
o	Hepatocellular carcinoma
o	Glomerulonephritis
o	Polyarteritis nodosa
o	Cryoglobulinaemia
35
Q

what are the infective stages of hepatitis B?

A

active, initial immune response windows phase, acute end or chronic state

36
Q

what is the serology of the active phase of hepatitis B?

A

HBsAg is present and showing posistive – viral DNA + E antigen also
o Antibodies are produced from IgM against HBcAg

37
Q

what are the serological features of the windows phase of hepatitis B?

A

neither surface antigen or IgG are detected as levels are so low – can detect core IgM antibodies

38
Q

what is the serology in successful end of hepatitis B infection?

A

IgM

39
Q

what are the serology features if an immune response is unsuccessful in hepatitis B?

A

 Surface antugens detected, no IgG

 Also presence of HBV DNA and antigen presence

40
Q

what is the serology in healthy chronic state hepatitis B?

A

presence of surface antigen and core antibody but no E antigen

41
Q

what is the serology of infective chronic state hepatitis B?

A

HBsAg, JBcAg, e antigen (all present)

42
Q

what are the prevention methods for hepatitis B?

A

minimse exposure: safe blood, safe sex, needle exchange, prevention of needlesticks, screening of pregnant women
Vaccination

43
Q

what is the management of hepatitis B?

A

o Pegylated interferon – alpha used
o Other anti-virals – tenofovir and entecavir
o Post exposure prophylaxis - vaccine, plus HBIG

44
Q

what is the virology of hepatitis D?

A

single stranded RNA virus

45
Q

what needs to be present for hepatitis D infection?

A

o Requires Hep B surface antigen to complete replication and transmission cycle
Co infection or super infection

46
Q

what are the clinical features of hepatitis D?

A

o Link with superinfection

o High risk of fulminant hepatitis (pregnancy), chronic hepatitis, cirrhosis

47
Q

what is the diagnostic test for hepatitis D?

A

reverse PCR reaction of hepatitis D RNA

48
Q

what is the management of hepatitis D?

A

interferon

Gastroenterology (4 decks)

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